9.11.1.2.2 Endophthalmitis and scleral abscess.9.11.1.2.1 Increased intraocular pressure.9.11.1.2 Selected Postoperative Complications.9.11.1.1.6 Complications of intravitreal gas injections.9.11.1.1.5 “Fishmouthing” of retinal breaks.9.11.1.1.4 Complications of draining subretinal fluid.9.11.1.1.3 Scleral perforation with suture needles.9.11.1.1 Selected Intraoperative Complications.9.11.1 Common complications of scleral buckling.9.8.1 Intravitreal injection of balanced salt solution.9.4 Thermal treatment of retinal breaks.9.2 Conjunctival incision and isolation of rectus muscles.However, there are conditions under which scleral buckle surgery may be necessary and advisable. Double vision can occasionally occur following surgery which may require prism glasses or additional surgery.īecause these complications are not usually seen after vitrectomy surgery ( see “Vitrectomy surgery” for a more complete discussion), scleral buckle surgery has largely been supplanted. Another rare complication is reopening of the wound with extrusion of the silicone material after the surgery, requiring surgical removal of the silicone. Some patients complain that they can feel the silicone material in the eye long after the surgery, but this is uncommon. Dissolvable sutures are used to close the wound at the end of the procedure and a sensation in the eye like a foreign body from the stitches is common for several weeks after surgery. A larger incision must be made in the eye than for vitrectomy surgery, so the postoperative recovery period tends to have more pain and discomfort that vitrectomy surgery. The silicone material is left in the eye permanently and in most cases this does not cause any problems. It does have some disadvantages over vitrectomy surgery. The surgery is very successful in most cases and it can be a very appropriate choice in some cases. ![]() Laser or cryopexy can then be used to seal the retina holes. A small hole can then be made in a noncritical area of the retina and the fluid can be extracted from under the retina with suction. Scleral buckle surgery is sometimes combined with vitrectomy surgery, where the surgeon uses small instruments to enter the eye and remove some of the gel. Over a period of weeks the areas treated form a scar which tightly and permanently binds the retina to the wall of the eye and prevents fluid from entering the holes. Either laser treatment or cryopexy (creating small frozen spots around the retinal holes) is used to stimulate the production of fibrin, which is a natural tissue glue, to seal the holes. A small hole is sometimes created to drain the fluid from under the retina and close the holes. The scleral buckle is intended to indent the wall of the eye where the retinal holes have formed, thereby bringing the inside wall of the eye closer to the retinal holes, closing the holes and relieving the pulling force of the gel on the retina. As the gel continues to pull on the retina, fluid from inside the eye can get through the hole and dissect between the retina and the wall of the eye causing a the retina to detach. When the gel shrinks it pulls on the retina which can cause a retinal tear to develop. However, on rare occasions the gel can be abnormally adherent to the retina or there can be thin spots in the retina. This is a normal aging process which frequently results in floater ( see “ Floaters”) as the gel peals away from the retina. The cause of many retinal detachments is contraction and shrinkage of the vitreous gel that fills the inside cavity of the eye. The purpose of these maneuvers is to indent or “buckle” the wall of the eye inward. ![]() This can be accomplished either by sewing the silicone piece to the sclera, dissecting a layer of the sclera and implanting the piece within the sclera, or creating tunnels in the sclera and encircling the globe with a silicone band which runs through the tunnels and is secured together at the ends like a belt. ![]() Although this procedure is used less frequently that it was in the past, it is still used at times either as a single procedure, or in combination with vitrectomy surgery.ĭuring scleral buckle surgery a piece of silicone rubber, either a solid piece or a sponge, is attached to the external wall of the eye (the sclera) which is a tough, leathery tissue. A scleral buckle is a type of surgical procedure performed to reattach a detached retina.
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